超声对老年急性心肌梗死患者左心室心肌总应变及左心室重构的研究  

Application of echocardiography in assessing left ventriccular myocardial main strain and remodeling in elderly AMI patients

作　　者：邓玉姣 陈薇 黄鑫[2] 洛佳坤 马宇飞 于焱 王一茹[1] 李越[1] 罗渝昆[1] Deng Yujiao;Chen Wei;Huang Xin;Luo Jiakun;Ma Yufei;Yu Yan;Wang Yiru;Li Yue;Luo Yukun(Department of Ultrasound,Chinese PLA General Hospital No.1 Medical Center,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声科,北京100853 [2]解放军总医院第二医学中心心内科国家老年疾病临床医学研究中心 [3]北京卫戍区丰台第十六离职干部休养所门诊部

出　　处：《中华老年心脑血管病杂志》2021年第7期696-699,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：解放军总医院军事医学青年扶持项目(QNF19033)

摘　　要：目的探讨应用超声技术评价老年急性心肌梗死(AMI)患者左心室心肌总应变,及其与左心室重构的相关性。方法选择心肌梗死患者104例,根据冠状动脉造影结果分为左回旋支(LCX)和(或)右冠状动脉(RCA)病变组(LCX/RCA组)31例、单纯左前降支(LAD)病变组(LAD单支组)34例、包含LAD的2支或3支病变组(多支组)39例,另选择性别、年龄相匹配的同期健康体检者40例为对照组。应用二维超声斑点追踪成像测算左心室各节段心肌及整体总应变矢量(ε)及其与左心室短轴平面间的角度(θ),应用实时三维超声心动图测算左心室重构指数(LVRI)。结果与对照组比较,LCX/RCA组左心室前壁ε,LAD单支组下侧壁、下壁ε未见明显减低(P>0.05),LCX/RCA组、LAD单支组、LAD多支组其余不同心肌节段ε明显减低(P<0.05),且LCX/RCA组下侧壁、下壁θ,LAD单支组前间隔、前壁θ及多支组各部位θ明显升高(P<0.05)。与对照组比较,LCX/RCA组、LAD单支组和LAD多支组整体ε、LVRI均显著降低,整体θ显著升高(P<0.05)。LCX/RCA组、LAD单支组和多支组整体ε(r=-0.815,P=0.014;r=-0.747,P=0.031;r=-0.768,P=0.024)、θ(r=-0.719,P=0.043;r=-0.763,P=0.021;r=-0.753,P=0.029)均与LVRI呈显著负相关。结论老年AMI患者左心室心肌ε大小及θ能反映局部及整体的心肌应变能力,整体ε、θ与LVRI均呈负相关性。Objective To assess the association between left ventricular myocardial main strain and remodeling in elderly acute myocardial infarction(AMI)patients by echocardiography.Methods One hundred and four elderly AMI patients were divided into left coronary artery circumflex branch and/or right coronary artery(LCX/RCA)stenosis group(n=31),single left coronary artery decending(LAD)branch stenosis group(n=34)and multiple LAD stenosis group(n=39)according to their coronary artery angiography with 40 sex-and age-matched persons undergoing physical examination during the same period served as a control group.The value(ε)and angle(θ)of left ventricular myocardial main strain vector in 4 groups were assayed by two-dimensional speckle tracking imaging,the left ventricular remodeling index(LVRI)in 4 groups was detected by RT 3-dimensional echocardiography.Results No significant difference was detected in theεof left ventricular anterior wall of LCX/RCA stenosis group,in inferior lateral wall and inferior wall of single LAD stenosis group(P>0.05).Theεof left ventricular anterior wall was significantly lower while theθof inferior lateral wall and inferior wall,anterior wall and anterior interventricular septum,anterior lateral wall and posterior intervene-tricular septum was significantly higher in LCX/RCA stenosis group,single LAD stenosis group and multiple LAD stenosis group than in control group(P<0.05).The globalεand LVRI were significantly lower while the globalθwas significantly higher in LCX/RCA stenosis group,single LAD stenosis group and multiple LAD stenosis group than in control group(P<0.05).The globalεandθwere negatively related with the LVRI in LCX/RCA stenosis group,single LAD stenosis group and multiple LAD stenosis group(r=-0.815,r=-0.747,r=-0.768,P<0.05;r=-0.719,r=-0.763,r=-0.753,P<0.05).Conclusion Theεandθcan indicate the local and global left ventricular myocardial main strain and are negatively related with the LVRI in elderly AMI patients.

关 键 词：心肌梗死 心室重构 冠状血管造影术 心肌 

分 类 号：R542.22[医药卫生—心血管疾病]